Association between person-centredness and financially driven postponement of care in European primary care: a cross-sectional multicountry study.

BACKGROUND: Previous research has shown that person-centred care has beneficial effects on several health-related outcomes. We investigated the association between a general practitioner's person-centred attitude and financially driven postponement of care in European countries.
METHODS: In this cross-sectional study, data were collected within the Quality and Costs of Primary Care in Europe study, which included 69 201 patients and 7183 general practitioners from 31 European countries (all 27 European Union member states, 2 candidate states [former Yugoslav Republic of Macedonia and Turkey], Norway and Switzerland). Financially driven postponement of care was measured by asking patients whether they had postponed care for financial reasons in the previous 12 months. We constructed a variable for person-centredness using a previously published conceptual framework: 1) exploring both the disease and the illness experience, 2) understanding the whole person, 3) finding common ground and 4) enhancing the patient-physician relationship. We analyzed the data using multilevel logistic regression modelling, adjusting for the strength of a country's primary care system.
RESULTS: Having a low income was associated with higher financially driven postponement of care. General practitioners with a person-centred attitude were associated with lower rates of financially driven postponement among their patients. An increase in general practitioners' person-centredness with 1 standard deviation was associated with a decreased likelihood of postponement of care for financial reasons (odds ratio 0.923, 95% confidence interval 0.869-0.981).
INTERPRETATION: Person-centred care by general practitioners in Europe was associated with lower financially driven postponement of care, irrespective of the strength of a country's primary care system. Copyright 2018, Joule Inc. or its licensors.